In the 1980s, HIV/AIDS was a “distant” disease represented by statistical data. Now, it is the “undisputed equalizer”, infiltrating all aspects of life. Jennifer Chiriga looks at the reasons for its spread, provides some pointers on fighting it and argues for the urgent need to defend and justify the public sector and public ownership of resources when it comes to health care.

In the mid 80s when I was a student at the university, HIV/AIDS was nothing more than statistical data, which had nothing to do with me. Then I heard that one of our lecturers was HIV positive. The disease and the people afflicted with it ceased to be a distant phenomenon and it stared me right in the face when the lecturer came into the lecture theatre looking weak, thin, and shockingly unfamiliar. Over the years since then, I have watched friends and family infected and affected by this disease. It is about human beings - not only facts and figures, and it is an undisputed equalizer. Rich or poor, illiterate or educated, the impact is the same.

The aggressiveness with which AIDS has insinuated itself into our lives leaves one no choice but to reflect on the colossal cost and burden of HIV/AIDS on the individual, the family and governments. HIV/AIDS is no longer just an issue for health authorities as it affects all aspects of life and has a devastating impact on all population groups and sectors of the national economy. What is even more worrisome is the regional dynamic where HIV/AIDS does not just affect individual countries in the region but whole regions.

I personally agree with the view that the problem of HIV/AIDS in the region is not just a health issue but has fundamentally become a development issue, mainly because the disease exacerbates existing problems such as poverty, food insecurity, shortage of skilled manpower and strained and dysfunctional social and economic institutions. The fact that most economies in the region are weak and largely dependent on donor funding further aggravates the situation.

A number of policy challenges present themselves, especially in the current scenario of political and economic disintegration. The frighteningly high levels of inflation and unemployment, erratic or stagnant economic performance and declining currency values all symbolize the economic crisis which is affecting people’s capacity to look after themselves and their health. For examples 80% of Zimbabweans are living in poverty and are unable to cope. Poverty is therefore worsening an already bad situation.

Within the health sector, increases in health fees as part of the effort to recover costs and improve efficiency in service delivery, has pushed the cost of health services beyond the reach of most vulnerable households, and health insurance costs continue to escalate inexorably. The informal sector and the notion of home-based care have absorbed the shocks of the epidemic. This has allowed the government and the private sector to sit back and pretend that the situation is under control. In essence, governments have abdicated (whether voluntarily or involuntarily) their responsibility to be in the forefront of service delivery. The private sector needs to work in tandem with government to create a vision beyond the profit margin, and to start getting involved in community service in a meaningful way.

At the broad policy level, it would appear the early post-independence experience of African countries has unfortunately been ignored. In most African countries there were state-led models of development and it is clearly established that there were major strides in this time – educational development and reduction of illiteracy through public-led education drives, huge improvement in health indicators, child mortality etc, and housing and transport was provided by the state. After governments in the region adopted cost recovery under IMF and World Bank austerity programmes, this led to increasing social inequalities (e.g. private hospitals and private schools becoming accessible to only the few who can afford them). Given the pre-dominance of AIDS, the health sector is one of the main areas through which there is an urgent need to defend and justify the public sector and public ownership of resources.

There are a number of important interventions (but by no means exhaustive) that policy makers need to reflect on:

1. There is need for a number of interventions to establish the magnitude of the HIV/AIDS crisis as well as investigating why despite many attempts to contain the scourge, the disease has gathered momentum in SADC to a level of being one of the biggest challenges to policy making and intervention. Why is there a higher rate of infection in Botswana than in Nigeria or Angola? What have Ugandans done to gain prominence as having achieved a measure of success in containing the virus?

2. Assessment of drug utilisation, availability, and cost are critical factors for policy formulation. So is assessment of impact of AIDS on food security and agricultural production. We must know the impact on the youth – the most productive sector, as well as the impact on women and children who bear the burden of home-based care.

3. The private sector has the capacity to make inroads through a number of interventions, e.g. provision of medicines, support of home-based care, instituting feeding schemes for the vulnerable e.g. young children at risk of malnutrition. Banks and private industry are making super-profits at the moment but are not ploughing any of those profits back into the communities that need propping up. There are many companies that one can think of – that would be the basis for a meaningful intervention.

4. In all this there is also a role for civic society. The Church, religious groups and other social movements can and should lead a campaign for behavioral change, and open dialogue at family and community level about the disease.

5. People providing home-based care, are doing so largely without proper training or equipment and so are at risk of infection or re-infection. People providing home-based care must be provided with knowledge and the necessary protective measures. Poverty reduction is also a pre-requisite for home-based care initiatives because we do know that a good diet is vital for boosting the immune system.

6. Is there anything being done to deal with the trauma and psychological impact on people, particularly children, of watching their parents dying slowly? People providing care also need care. Children are assuming adult roles and nothing is being done about the psychological effect.

7. What is the role of indigenous knowledge systems in traditional medicine? A lot of Africa’s people believe in traditional methods of treating illnesses. Governments should therefore support joint initiatives by traditional practitioners and scientists in an attempt to merge the traditional and conventional systems. This is already happening in some countries in the region, e.g. Zimbabwe, where there is collaborative research and development of medicines.

8. It is critical to empower young people with knowledge and awareness of HIV prevention. An informed youth will be able to negotiate a safe sex life to ensure good health.

9. Culturally relevant prevention information can be disseminated through the media, faith-based organizations, community groups, schools, and the workplace. To be effective, information must be packaged in an accessible manner, for example, showing sensitivity to rural folk’s taboo approach to sex, and finding the acceptable means to put the message across.

Over 40 million people were living with HIV/AIDS at the end of 2001, and more than 20 million have died since the virus was discovered in the 1980s. If these statistics do not make policy actors sit up and do something, HIV/AIDS will continue to decimate the world’s productive population.

* Jennifer Chiriga is Unit Coordinator at the Globalisation and Alternatives Unit at the Alternative Information and Development Centre (AIDC), Cape Town

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It is women who bear the brunt of the effects of trade liberalization on social development through a lack of access to basic social services. But, writes Jennifer Chiriga from the Alternative Information and Development Centre, one of the major impacts of trade on women is how the capitalist ethic plays into building masculinity while at the same time playing down the role that women play in society. Alternatives are in the offing, she argues.

The defining trends of current trade and economic relations across the globe and the process through which current international economic relations are played out, and markets for products and services are increasingly being defined, all fall under the rubric of globalisation.

International trade expansion has in the last few decades been manifesting a profound transformation, with the emergence of integration of economic activity, including elimination of restrictions on the free movement across borders of capital, goods, resources, technology and services. All regions of the world are coming closer together through intensified trade, investment, financial transactions, and information technology. Unfortunately the global expansion has not affected developing regions evenly, and Africa continues to lag behind.

The main feature of globalisation is a surge in the power of global capital and reorganizing of global production through multi-national corporations that wield tremendous influence over economies. Globalisation has been quite aptly cited as “largely the game of the powerful…the strong do what they will, and the weak must surrender what they cannot protect” (Tandon, cited in Vale and Maseko, 1998).

Other defining characteristics of globalisation are a more integrated global economy with interdependencies among nations, but the benefits of which accrue to developed economies; decline in investment in production, with companies moving more towards speculative investment, which brings faster and higher profits; diminishing public sector, with the state becoming more business oriented through privatisation of state enterprises, and the phenomenal power of multinational corporations that have the clout to drive global trade and influence governments, as seen by the power of the World Bank (WB), International Monetary Fund (IMF) and World Trade Organisation (WTO).

The WTO is not just about trade, it is about power and control of resources. Developed countries shape and control the trade regimes that affect developing countries and that lead to de-industrialisation, job losses and worsening of poverty. This is evidenced by the experience of developing countries that are undergoing IMF/World Bank enforced trade through neo-liberal structural adjustment programmes, who have been forced to liberalise their external trade, and have subsequently suffered destruction of local industries leading to massive retrenchments.

In spite of the conventional understanding about the creation of an “open” global free trade system, there is very limited “free trade”, particularly for African countries. The relevance of the WTO in the world system is that it is seen as the central institution in a centralised global economy. This has major relevance for African countries as they grapple with huge development challenges. The external orientation of African countries has led to opening up of global markets, resulting in flooding of imports and domination of foreign products e.g. agricultural produce and textiles to name a few, and this has led to massive loss of jobs in rural and urban sectors, threats to food security and abandonment of the social development project. The effects of trade liberalisation on social development is evidenced by lack of access to basic social services, a scenario in which women bear the greater burden.

Gender and trade

One of the major factors in gender inequality relates to how negative perceptions mould gender differences and how the capitalist ethic plays into building masculinity while at the same time playing down the role that women play in society where they occupy the role of secondary earners. Gender is a key determinant of vulnerability to poverty. And women, due to their disadvantaged position in the labour market, hold lower paid jobs, which require lower level of skills etc.

Although gender analysts have for a long time emphasised the negative impacts of trade liberalisation, the link between gender and trade has been tenuous, largely because perhaps gender considerations have been perceived as irrelevant and having no place at the negotiation table where trade issues are discussed. Looked at through a gender prism, trade policies have grave implications for development and well-being of women, due to impact on employment, poverty and the social burden carried by women. Although women are an important and significant constituency, trade policy in the WTO is formulated with no evidence of a gender perspective.

A study on policy links between gender and trade (Informal Working Group on Gender and Trade, 1998) emerged with a number of “reality points” that link gender and trade, and make a case for the importance of putting gender analysis at the center of trade policy:

a) Changes in social service delivery affect women to a greater extent

Trade policies and trade liberalisation can affect the ability of governments to finance social sector expenditure. The observation is that any revenue shortfalls leading to reduction of government expenditure affects social service delivery, and the burden is shifted to the households and women. The study states that in 1993 women contributed over US$11 trillion worth of household work to the world economy, and that trade policy should therefore not ignore women’s unwaged work in social reproduction. Gender planning should be built into the design of trade policies. A very important point made is that social development should be the bedrock of trade policy since women’s traditional roles do not make it easy for them to access opportunities to engage in international trade.

b) Entrenched gender inequalities in the labour market are unfavourable to women

The labour market tends to be segmented on gender lines with inequalities in income, career advancement and conditions of work. Traditionally expansion of trade is based on access to low wage labour, which is mainly female labour. Liberalisation of trade and the surge of foreign capital and transnational corporations, maintain competitiveness through minimising costs of production, especially labour costs. While one can generalise the negative effects on the labour market, for women the impact is higher – they have lower wages and less bargaining power because unions tend to be dominated by male leadership. The danger of trade liberalisation bringing more hardship for women is very real – because sub-contracting and flexible work allows corporations to avoid direct financial responsibility for workers.

c) Women have lesser access to economic resources: credit, skills, technical assistance

Institutionalised discrimination affects women’s access to land and credit from financial institutions, and therefore impacts in a very fundamental way on their role in the economy. When trade barriers are reduced and an infusion of cheaper imports come into the market, women may lose out especially when quality control becomes an issue and introduces lack of competitiveness.

One of the major gaps is that while WTO rules encompass all levels of economic development, there is no gender analysis that assesses these rules in a structured way. While there is a ready source of scientific research documenting the realities of women’s lives and how the economy impacts on them, the conceptual and policy links between gender and trade have to be given more attention and attempts to generate further analysis on the link between gender and trade policy, should raise the following questions:

- Are trade policies geared towards elimination of poverty and gender inequality?

- Do trade rules prevent government and private business from formulating gender-sensitive policies;

- Are trade policies based on competition, which ignores reproductive tasks i.e. reinforcing the masculine model of superiority.

Even as we grapple with the specific gender dimensions, trade policy should not be approached in isolation of macro level economic policy. In this context, the discussion on alternatives raises very broad issues.

Alternative strategies for development

Change is possible through a break from the mainstream model of dominant global capital. The emergence of national, regional and international forums such as the Africa Social Forum (ASF) and World Social Forum (WSF) is a sign that there is an increasing trend of organisations and social movements mobilising to reflect and exchange ideas on alternative visions and actions. The WSF was conceived as a response to the growing struggle against neo-liberalism and an alternative to the World Economic Forum where business leaders from all over the world get together to discuss the economic state of the world, and is an arena of debate, as well as an opportunity for social movements and activists from the north and south to meet and exchange ideas.

There is already a powerful discourse, which is however being undermined by concentration of wealth and anti-democratic power of powerful global corporations. Nevertheless, emergence of regionalism as an alternative, is gaining ground as a possible solution to the dislocation of Africa’s economic potential.

The questions to pose in any deliberations on alternatives are:

- how to engender the political will necessary for the regional project;

- how the geo-political concept of regionalism can be harnessed to engage and challenge the globalised system on a stronger footing;

- how Africa can turn regional integration and cooperation groupings into real frameworks for alternative models of development.

Africa already has some examples of a unique regional integration model that have roots in pan African solidarity. There is potential for strengthened regional blocs to encompass development needs of emerging economies. Regional integration has the potential to break the leverage that industrial countries have over Africa, whose governments need to realise that engaging the local with the regional and continental is the future in terms of economic development.

In response to the questions raised above, one of the key considerations is that social mobilisation of strong social movements and organisations can provide the pressure and impetus that will eventually cause a shift in the global balance of power. Social movements should be the foundation of a people-based process that promotes developmental regionalism, centred on human rights, women’s rights and social justice. Commitment should be to a unified region in which local and community-based development is the primary underpinning of national and regional development programmes.

Through strategic interdependencies we need to redirect trade to domestic and regional spaces, increase manufacturing and production and add value to our primary products. In addition the liberalisation and privatisation policies should be replaced and we should create trade and development cooperation agreements which reflect the realities and needs of the people, and which are not pre-determined or constricted by compliance with WTO terms and conditionalities.

Cooperative development would ensure, for example, that shared resources like energy, water etc, could be approached holistically for the benefit of the whole region. But as long as powerful economies like South Africa continue following a sub-imperialist agenda, it will be a lost battle. African governments must cooperate, coordinate and combine. As someone said at a workshop recently, “extroverted economies will get us nowhere".

* Jennifer Chiriga is Unit Coordinator, Globalisation and Alternatives Unit, Alternative Information and Development Centre (AIDC), Cape Town

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Article traduit de l’anglais par Frances Chevalier et Kesini Murugesan, de l’Université du Cap, Afrique du Sud.